Discusses hepatitis C, a disease caused by a virus that infects the liver. Covers causes and symptoms. Includes info on the two phases, acute and chronic. Includes info on cirrhosis. Covers treatment with antiviral medicines and surgery.

Hepatitis C

Topic Overview

What is hepatitis C?

Hepatitis C is a disease
caused by a
virus that infects the
liver. In time, it can lead to cirrhosis, liver cancer, and liver failure.

Many people don't know that they have hepatitis C until they already
have some liver damage. This can take many years. Some people who get hepatitis
C have it for a short time and then get better. This is called acute hepatitis
C. But most people who are infected with the virus go on to develop long-term,
or chronic, hepatitis C.

Although hepatitis C can be very serious,
most people can manage the disease and lead active, full lives.

What causes hepatitis C infection?

Hepatitis C is
caused by the hepatitis C virus. It is spread by contact with an infected
person's blood.

You can get hepatitis C if:

You share needles and other equipment used to
inject illegal drugs. This is the most common way to get hepatitis C in the
United States.

You had a blood transfusion or organ transplant
before 1992. As of 1992 in the United States, all donated blood and organs are
screened for hepatitis C.

You get a shot with a needle that has infected blood on it.
This happens in some developing countries where they use needles more than once
when giving shots.

You get a tattoo or a piercing with a needle
that has infected blood on it. This can happen if equipment isn't cleaned
properly after it is used.

In rare cases, a mother with hepatitis C spreads the
virus to her baby at birth, or a health care worker is accidentally exposed to
blood that is infected with hepatitis C.

The risk of getting hepatitis C through sexual contact is very small.1 The risk is
higher if you have many sex
partners.

You
cannot get hepatitis C from casual contact such as
hugging, kissing, sneezing, coughing, or sharing food or drink.

What are the symptoms?

Most people have no
symptoms when they are first infected with the hepatitis C virus. If you do
develop symptoms, they may include:

Feeling very tired.

Joint
pain.

Belly pain.

Itchy skin.

Sore
muscles.

Dark urine.

Yellowish eyes and skin (jaundice). Jaundice usually appears only after other
symptoms have started to go away.

Most people go on to develop chronic hepatitis C but
still don't have symptoms. This makes it common for people to have hepatitis C
for 15 years or longer before it is diagnosed.

How is hepatitis C diagnosed?

Many people find out by accident that they have the virus. They find out when
their blood is tested before a blood donation or as part of a routine checkup. Often people with hepatitis C have high levels of liver
enzymes in their blood.

If your doctor
thinks you may have hepatitis C, he or she will talk to you about having a
blood test. If the test shows hepatitis C
antibodies, then you have had hepatitis C at some point. A
second test can tell if you still have hepatitis C.

When blood tests
show that you have hepatitis C, you may need a
liver biopsy to see if the virus has caused scarring
in your liver. During a liver biopsy, a doctor will insert a needle between
your ribs to collect a small sample of liver tissue to look at under a
microscope.

Some people prefer to
find out on their own if they have been exposed to hepatitis C. You can buy a
home test called a Home Access Hepatitis C Check kit at most drugstores. If the
test shows that you have been exposed to the virus in the past, be sure to talk
to your doctor to find out if you have the virus now.

How is it treated?

You and your doctor need to
decide if you should take antiviral medicine to treat hepatitis C. It may not
be right for everyone.

If you do take medicine, the best treatment is a
combination of medicines that fight infection. Examples of medicines used include peginterferon, ribavirin, sofosbuvir, and telaprevir.
How well these medicines work depends on how damaged your liver is, how serious your infection is, and what type of hepatitis C you have.

Taking care of yourself is an important part of the treatment for
hepatitis C. Some people with hepatitis C don't notice a change in the way
they feel. Others feel tired, sick, or depressed. You may feel better if you
exercise and eat healthy foods. To help prevent further liver damage, avoid
alcohol and illegal drugs and certain medicines that can be hard on your
liver.

Cause

Hepatitis C is
a liver disease that is caused by infection with the hepatitis C virus, a virus
that lives in your liver cells.

How it spreads

You cannot
get hepatitis C from casual contact such as hugging, kissing, sneezing,
coughing, or sharing food or water with someone. You can
get hepatitis C if you come into contact with the blood of someone who has
hepatitis C.

The most common way to get hepatitis C is by sharing
needles and other equipment (such as cotton, spoons, and water) used to inject
illegal drugs.

Before 1992,
people could get hepatitis C through blood transfusions and organ transplants.
Since 1992, all donated blood and organs are screened for hepatitis C, so it is
now rare to get the virus this way.

In rare cases, a mother with
hepatitis C spreads the virus to her baby at birth, or a health care worker is
accidentally exposed to blood that is infected with hepatitis C.

The risk of getting hepatitis C through sexual contact is very small.1 The risk is
higher if you have many sex
partners.

If you live with someone who has hepatitis C or you
know someone who has hepatitis C, you generally don't need to worry about getting
the disease from that person. You can help protect yourself by not sharing anything that may
have blood on it, such as razors, toothbrushes, and nail clippers.

Symptoms

Most people who are infected
with hepatitis C—even people who have been
infected for a while—usually don't have symptoms.

If symptoms do develop,
they may include:

Fatigue.

Joint
pain.

Belly pain.

Itchy skin.

Sore
muscles.

Dark urine.

Jaundice, a
condition in which the skin and the whites of the eyes look yellow.

A hepatitis C infection can cause damage to your liver (cirrhosis). If you develop cirrhosis, you may
have:

Redness on the palms of your hands caused by
expanded small blood vessels.

Clusters of blood vessels just below
the skin that look like tiny red spiders and usually appear on your chest,
shoulders, and face.

Swelling of your belly, legs, and
feet.

Shrinking of the muscles.

Bleeding from enlarged veins in your digestive tract, which is
called variceal bleeding.

Damage to your brain
and nervous system, which is called encephalopathy. This damage can cause
symptoms such as confusion and memory and concentration problems.

Many other health problems are linked with long-term
cirrhosis. For more information, see the topic
Cirrhosis. There also are many
other conditions with similar symptoms, such as other liver infections and liver damage caused by drinking too much alcohol.

Contagious and incubation periods

The incubation
period—the time it takes for symptoms to appear after the hepatitis C virus
has entered your body—is from 2 weeks to 6 months. But not all people have symptoms when they are first infected.

You can spread the virus to someone else at any time after you are infected, even if you don't have symptoms.

What Happens

There are two phases of
hepatitis C. The first form is called acute hepatitis C. It means that you recently became
infected with the virus. The second form is called chronic hepatitis C. It which means that you have had an
infection for more than 6 months.

Acute phase

Right after you are infected with
hepatitis C, you enter the acute
stage. Some people fight off the virus
and never have any liver problems. But up to 85% of people who are
infected will go on to have chronic hepatitis
C.2

Most people have no symptoms
right after they have been infected with hepatitis C. Your symptoms may be
blamed on
the flu. Since any symptoms are likely to go away in a
few weeks, you may not know you have hepatitis C for a long time.

If you have an obvious symptom of hepatitis C, such as
jaundice, or if you know you have been exposed to the
blood of someone who has hepatitis C, you should be
tested for hepatitis C virus infection.

Chronic phase

Long-term hepatitis C
often causes tiny scars in your liver. If you have a lot
of these scars, it becomes hard for your liver to work well. About 25% of
people who develop chronic hepatitis C eventually have more serious liver
problems such as
cirrhosis or liver cancer, usually over a period of 20
or more years.3

If the infection becomes
so severe that your liver can no longer function (end-stage liver failure),
having a
liver transplant may be the only way to extend your
life.

What Increases Your Risk

Certain things may increase
your risk of becoming infected with the
hepatitis C virus. Just because you are at risk for
getting hepatitis C does not mean that you have the virus.

Many people do not know how they became infected with hepatitis C.

Needle use or accidental stick

You can get hepatitis C from:

Sharing needles and other equipment (such as
cotton, spoons, and water) used to inject drugs.

Having your ears
or another body part pierced, getting a tattoo, or having
acupuncture with needles that have not been sterilized
properly. The risk of getting hepatitis C in these ways is very
low.

Working in a health care environment where you are exposed to
fresh blood or where you may be pricked with a used needle. Following standard
precautions for health care workers makes this risk very low.

Other possible risks

Sometimes people get hepatitis C from:

Having had a blood transfusion or organ
transplant before 1992. Since 1992, all donated blood and organs are screened for hepatitis C.

Having been exposed to unsafe practices for giving shots, such as
reusing needles. This occurs in some developing countries.

Exams and Tests

Because many people don't have symptoms, it's common for
people to have hepatitis C for 15 years or longer before it is diagnosed. Many
people don't find out that they have the virus until they are tested for some other reason, such as when donating
blood. Experts recommend that all adults born from 1945 to 1965 should be tested for hepatitis C.4, 5 People in this age group are more likely to have hepatitis C and not know it.

It is important to be tested for hepatitis C if
you:

Have signs or symptoms of liver disease, such
as abnormal liver tests.

Received blood from a donor who was found
to have hepatitis C.

Have ever shared needles while using drugs,
even if you only experimented many years ago.

Are a health care
worker who may have been exposed to hepatitis C through a needle stick or other
contact with blood or body fluids.

Have many sex partners or have a sex partner who has a
chronic hepatitis C infection.

Have had
your blood filtered by a machine (hemodialysis) because your kidneys cannot
filter your blood.

Received blood, blood products, or a solid organ
from a donor before 1992. Since 1992, all donated blood and organs are screened
for hepatitis C. So it is now rare to get the virus this
way.

Received blood-clotting factor concentrates (used to treat
blood disorders such as
hemophilia) before 1987. In 1987, screening of
clotting factor concentrates for hepatitis C became a requirement.

Before you have
tests, your doctor will probably talk to you about the
pros and cons of testing for hepatitis C so that you
understand what having the virus means.

First exam at the doctor's office

Check your liver enzymes to see if they are high. This may be the first sign that you have the
virus.

Tests for the hepatitis C virus

If your doctor
thinks that you may have hepatitis C, he or she may order:

A hepatitis C virus test. This is a blood test that
looks for
antibodies against the hepatitis C virus. It shows whether you have been exposed to the virus. A rapid test is available that gives results in 20 minutes.

A blood test that looks for the
genetic material (RNA) of the hepatitis C virus. This
test shows whether you are infected with the virus now.

A blood test to find out the kind of hepatitis C
virus (genotype) you have. Knowing your genotype will help you and your doctor decide if and how you
should be treated.

Home testing for hepatitis C

Some people prefer to find out on their own whether they
have been exposed to hepatitis C. In most drugstores you can buy a
home test called the Home Access Hepatitis C Check kit. If test results show
that you have been exposed to the virus, it is important to discuss these
results with your doctor and to find out if you are infected with the virus
now.

Tests for liver problems

To check how well your liver is working, you may have:

Liver function tests. These are blood tests that can
help your doctor find out if you have liver damage.

The medicines used to treat hepatitis C can cause serious
side effects, are expensive, and don't work for everyone.

Being diagnosed with
hepatitis C can change your life. You may need help and support to cope with the illness. For more information, see Home Treatment.

Treatment of short-term (acute) hepatitis C

Most
people who have acute hepatitis C don't get treated, because they don't know that they
have the virus.

If a person knows that he or she may have been
exposed to the virus—such as a health care worker who is stuck by a
needle—acute hepatitis C can be found early. Most people who are known to
have an acute hepatitis C infection get treated with medicine. In these cases,
treatment may help prevent long-term (chronic) infection,
although there is still some debate over when to begin treatment and how long
to treat acute hepatitis C.6

Treatment of long-term (chronic) hepatitis C

It
is common for people to live with hepatitis C for years without knowing they
have it, because they do not have symptoms. So most people diagnosed with
hepatitis C find out that they already have long-term, chronic infection.

Treatment with a combination of antiviral medicines can fight the viral
infection and prevent serious liver problems like cirrhosis or liver cancer. They are used for 12 weeks to a year and help your body get rid of the virus.

Whether or not you take medicines to treat
hepatitis C, you will need to have routine blood tests
to help your doctor know how well your liver is working.

Some people who at first decide not to have
treatment later decide they want to have it.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.

You can have this care along with treatment to cure your illness. You can also have it if treatment to cure your illness no longer seems like a good choice.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

Treatment of relapse or nonresponse

Sometimes you can take a different combination of medicines if your
first round of treatment didn't work very well. The decision to try treatment
again is based on several things including how well you tolerated the first treatment and how well the
first round of treatment worked. Talk to your doctor about whether you might try
medicines again.

Treatment if the condition gets worse

Severe liver
damage caused by chronic
hepatitis C usually takes 20 or more years to develop.

If your hepatitis C continues to get worse, it can
cause your liver to stop working, a condition called end-stage liver failure.
In this case, a
liver transplant may be the only way to extend your
life. But if you are drinking alcohol, are sharing needles to inject drugs, or
have severe
depression or certain other mental illnesses, liver
transplant may not be an option.

End-of-life issues

Most people with chronic
hepatitis C will not die from the disease. But 1 to 5 out of 100 people with
severe liver damage from chronic
hepatitis C will die because of the virus.7 Even if a liver transplant is done as a last possible
treatment, there can be complications that lead to death. For more information
about decisions to help prepare for death and dying, see the topic
Care at the End of Life.

What to think about

There is no vaccine for hepatitis C, but there are vaccines for
hepatitis A and
hepatitis B. Your doctor may recommend that you have
these vaccines to help protect you from more liver problems.

Researchers are working
to develop other treatments, including gene therapy and medicines that help
control the immune system.

Prevention

There is no vaccine to prevent
hepatitis C. But you can reduce your risk of becoming
infected:

Don't share needles or other equipment (such as cotton, spoons, and water) if you inject drugs. Many cities have needle exchange programs that provide free, sterile needles so
that you don't have to share needles. If you want to stop using drugs, ask
your doctor or someone you trust to help you find out about drug treatment
programs.

Follow safety guidelines if you work in health care. Wear protective gloves and clothing, and
dispose of needles and other contaminated sharp objects
properly.

Make sure the practitioner sterilizes the instruments
and supplies if you get a tattoo, have your body pierced, or have
acupuncture.

If you have hepatitis C, you can help prevent spreading it
to others:

Don't share needles or other equipment
such as cotton, spoons, and water if you continue to use needles to inject
drugs.

Keep cuts, scrapes, and blisters covered to prevent others
from coming in contact with your blood and other body fluids. Throw out any
blood-soaked items such as used Band-Aids.

Don't donate blood
or sperm.

Wash your hands—and any object that has come in contact with
your blood—thoroughly with water and soap.

Breast-feeding mothers who have hepatitis C can continue to
breast-feed their babies, because hepatitis C cannot be spread through breast
milk. If you are breast-feeding, try to avoid having cracked
nipples, which might pose a risk of spreading the virus to your baby.

Home Treatment

Some people who have
hepatitis C don't notice a big difference in the way
they feel. Others feel tired, sick, or depressed. The following are steps you
can take at home that may help you feel better both physically and
emotionally.

Slow down

It is very common to feel tired if you
have hepatitis C. If you feel tired, give yourself permission to do less and
rest more. If possible, ask others to help out around your home or ask your
employer for a shorter or more flexible work schedule.

Exercise

Exercise if you feel up to it. Aerobic
exercise can help you have more energy and may also improve depression. It is
best to avoid any strenuous activities on the day after you receive
peginterferon.8

Eat regular, nutritious meals

Sometimes people
with hepatitis C have a hard time eating. You may have no appetite, feel
nauseated, or have different tastes than you are used to. Even if you don't
feel like eating, it's very important to eat small meals throughout the day.
Some people have nausea in the afternoon. If this happens to you, try to
eat a big, nutritious meal in the morning.

If you have cirrhosis,
it may not be a good idea to eat salty foods or foods that are high in protein.
If you want to know more about which foods to avoid and which foods are good to
eat, ask your doctor about meeting with a
registered dietitian to discuss a healthy eating
plan.

Avoid alcohol and drugs

One of the most important
jobs of your liver is to break down drugs and alcohol. If you have hepatitis C,
one of the best things you can do is to avoid substances that may harm your
liver, such as alcohol and illegal drugs. If you have cirrhosis, you also may
need to avoid certain medicines.

If you use illegal drugs or
drink alcohol, it is important to stop. Being honest with your doctor about your drug
and alcohol use will help you deal with any substance abuse problems. If you don't feel that you can talk openly with your doctor, you may want to find a
doctor you feel more comfortable with. If you want to stop using drugs or
alcohol and need help to do so, ask your doctor or someone else you trust about
drug and alcohol treatment options.

Because many medicines can
stress your liver, talk to your doctor before you take any prescription or
over-the-counter medicines. This includes herbal
remedies as well.

Control itching

If you have itchy skin, ask
your doctor about taking nonprescription medicines, such as diphenhydramine
(for example, Benadryl) or chlorpheniramine (for example, Chlor-Trimeton), to
relieve itching. If you do take these medicines, be sure to follow the
instructions and to stop using the medicine if you have any side
effects.

Seek help for depression

You may feel angry
or depressed about having to live with a long-term, serious disease.
You may have a hard time knowing how to tell other people that you have the
virus. It can be helpful to talk with a
social worker or counselor about what having the
disease means to you. You also may want to find a support group for people with
hepatitis C. If you don't have a support group in your area, there are several
on the Internet.

Depression may
develop in anyone who has a long-term illness. It also can be a side effect of
antiviral medicines for hepatitis C. If you are feeling depressed, talk to your
doctor about antidepressant medicines and/or counseling. For more information,
see the topic
Depression.

Learn about the disease

Learning about hepatitis C
may help you feel more in control of the disease. The more you understand, the
better you can make decisions about treatment and lifestyle changes that may
help you feel better, both physically and emotionally.

Medications

Most people who are known to have an
acute hepatitis C infection get treated with antiviral medicine. Treatment for acute hepatitis C may help prevent long-term (chronic) infection,
although there is still some debate over when to begin treatment and how long
to treat acute hepatitis C.6

Antiviral medicines also are used
to treat long-term (chronic)
hepatitis C. These medicines can help prevent the
hepatitis C
virus from damaging your liver.

Sometimes treatment doesn't permanently lower
the amount of virus in your blood. But some studies have shown that treatment
may still reduce scarring in your liver, which can lower your chances of
developing cirrhosis and liver cancer.9, 10

Medicine choices

Combination antiviral therapy is used to treat hepatitis C. The medicines used for treatment depend on the genotype of the virus you are infected with, how serious your infection is, and other health conditions you may have.

What to think about

Medicines to treat
hepatitis C don't work for everyone.

If you have tried
interferon in the past and didn't get good results, talk to a doctor who is a
liver specialist (hepatologist). He or she will be able to tell
you about new medicines that are producing good results and about experimental medicines that are being developed.

The length of your
treatment depends on what hepatitis C genotype you have. Genotypes 1 and 2 typically
are treated for 12 weeks. Genotype 3 typically is treated for 12 or 24 weeks.
If your viral load does not show signs of improvement
after initial treatment, a different set of medicines may be used.

It is important to weigh the benefits of medicines for hepatitis
C against the drawbacks. You most likely don't need to make a quick decision
about treatment, because hepatitis C progresses very slowly. New medicines are helping to cure hepatitis C in more people. Talking with your
doctor can help you decide whether medicines are right for you.

Surgery

If chronic
hepatitis C damages your liver so severely that it no
longer works well (end-stage liver failure), you may need a liver transplant to
extend your life. Liver transplants aren't common.

Surgery choices

A
liver transplant is the only surgical treatment that
can help people with end-stage liver failure.

What to think about

Liver transplantation is a
risky, expensive procedure. And donor organs are hard to get. Most of the
time, only people who are in good health (other than having liver disease) are
considered for a transplant. You will not be considered if you are drinking
alcohol, using illegal drugs, or have certain mental health problems.

After a
liver transplant, you will need lifelong follow-up care by a specialist. You
also will need to take immunosuppressant medicine to keep your body from
rejecting the new liver. This medicine may cause other problems.

Hepatitis C almost always infects the newly transplanted liver. Recurring
liver disease after a transplant can be a serious problem and may cause the new
organ to fail. But most patients do very well after a liver transplant and are
able to live normal lives.

Other Treatment

Some people seek out
complementary medicines or alternative ways to treat
their
hepatitis C. At this time, no complementary or
alternative medicines have been proved to reduce symptoms or cure hepatitis C.
In fact, some herbal therapies (such as
kava) may actually damage the liver.11

Rigorous studies of the herb
milk thistle show that it does not protect the liver from
damage.12, 13 Talk to your doctor if you are thinking about trying milk thistle
or any other complementary therapy to treat hepatitis C.

National Center for Complementary and Alternative
Medicine (2012). Get the Facts: Hepatitis C: A Focus on Herbal Supplements (NCCAM Publication No. D422). Washington,
DC: U.S. National Institutes of Health. Available online:
http://nccam.nih.gov/health/hepatitisc/hepatitiscfacts.htm.

Other Works Consulted

Centers for Disease Control and Prevention
(2005). Guidelines for Viral Hepatitis Surveillance and Case Management. Available online:
http://www.cdc.gov/hepatitis/Statistics/SurveillanceGuidelines.htm.

National Center for Complementary and Alternative
Medicine (2012). Get the Facts: Hepatitis C: A Focus on Herbal Supplements (NCCAM Publication No. D422). Washington,
DC: U.S. National Institutes of Health. Available online:
http://nccam.nih.gov/health/hepatitisc/hepatitiscfacts.htm.

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